TIPS vs Endoscopic Therapy for Variceal Rebleeding in Cirrhotic Patients With Portal Vein Thrombosis

Inclusion criteria 1. liver cirrhosis (histological or clinical); 2. Significant variceal bleeding \>5 days and ≤ 42 days 3. Successful treatment of the index bleed by means of vasoactive drugs and/or endoscopic treatment 4. Portal vein thrombosis occlusion\>=25% of the vessel lumen; 5. Presence of ascites 6. Child-Pugh score 8-12 at inclusion 7. Age 18 to 70 years Exclusion criteria 1. Bleeding from isolated gastric or ectopic varices 2. Contraindications to non-selective beta blockers (chronic obstructive pulmonary disease, asthma, aortic stenosis, atrioventricular block, intermittent claudication, and psychosis) 3. Contraindications to TIPS : extensive potral vein thrombosis, fibrotic cord replacing original main portal vein; bilirubin\>3.5 mg/dL, plasma creatinine\>2.1 mg/dL, Child-Pugh score \>=13points 4. A history of significant heart failure (New York Heart Association class III and IV) 5. Overt hepatic encephalopathy, 6. Prehepatic portal hypertension 7. Malignancy (including hepatocellular carcinoma) or a concomitant disease with reduced life expectancy 8. Uncontrolled infection and sepsis 9. Previous treatment to prevent rebleeding with a portosystemic shunt,TIPS or with pharmacological therapy with non-selective beta blockers and endoscopic variceal ligation 10. Pregnancy or lactation